Neuropediatrics 2009; 40(3): 144-147
DOI: 10.1055/s-0029-1243173
Short Communication

© Georg Thieme Verlag KG Stuttgart · New York

Central Pontine and Extrapontine Myelinolysis in a Pediatric Patient Following Rapid Correction of Hypernatremia

S. Mastrangelo1 , A. Arlotta1 , M. G. Cefalo1 , P. Maurizi1 , A. Cianfoni2 , R. Riccardi1
  • 1Division of Pediatric Oncology, Catholic University, Rome, Italy
  • 2Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
Further Information

Publication History

received 25.06.2009

accepted 19.10.2009

Publication Date:
17 December 2009 (online)

Abstract

Central pontine and extrapontine myelinolysis are uncommon disorders characterized by distinctive clinical features and typical findings on neuroimaging. Only a few cases are reported in the pediatric age group. We describe the case of a leukemic, malnourished 14-year-old boy with a high serum sodium concentration that gradually increased to 170 mmol/L. During a septic shock episode, hydration with a low sodium concentration at the rate of 104 mL/h for 24 h was administered. A rapid correction of the high serum sodium occurred, exceeding 0.5 mmol/L/h. The following day the patient developed rapid and progressive neurological impairment with clinical features characteristic of central pontine and extrapontine myelinolysis. Magnetic resonance imaging confirmed the diagnosis 11 days later. The patient was treated with steroids and intravenous immunoglobulins. He achieved an almost full neurological recovery and radiological improvement. The reported case demonstrates that central pontine and extrapontine myelinolysis can occur after excessively rapid correction of hypernatremia.

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Correspondence

Dr. Stefano Mastrangelo

Division of Pediatric Oncology

Catholic University of Rome Gemelli Hospital

Largo A. Gemelli, 8

00168 Rome

Italy

Phone: +39/06/305 8203

Fax: +39/06/305 2751

Email: stefano.mastrangelo@rm.unicatt.it

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